§ 5106 — Fair claims settlement

New York § 5106

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 51: Comprehensive Motor Vehicle Insurance Reparations

Text

§ 5106. Fair claims settlement. (a) Payments of first party benefits\nand additional first party benefits shall be made as the loss is\nincurred. Such benefits are overdue if not paid within thirty days\nafter the claimant supplies proof of the fact and amount of loss\nsustained. If proof is not supplied as to the entire claim, the amount\nwhich is supported by proof is overdue if not paid within thirty days\nafter such proof is supplied. All overdue payments shall bear interest\nat the rate of two percent per month. If a valid claim or portion was\noverdue, the claimant shall also be entitled to recover his attorney's\nreasonable fee, for services necessarily performed in connection with\nsecuring payment of the overdue claim, subject to limitations\npromulgated by the superintendent in regulations.\n (b) Every insurer shall provide a claimant with the option of\nsubmitting any dispute involving the insurer's liability to pay first\nparty benefits, or additional first party benefits, the amount thereof\nor any other matter which may arise pursuant to subsection (a) of this\nsection to arbitration pursuant to simplified procedures to be\npromulgated or approved by the superintendent. Such simplified\nprocedures shall include an expedited eligibility hearing option, when\nrequired, to designate the insurer for first party benefits pursuant to\nsubsection (d) of this section. The expedited eligibility hearing option\nshall be a forum for eligibility disputes only, and shall not include\nthe submission of any particular bill, payment or claim for any specific\nbenefit for adjudication, nor shall it consider any other defense to\npayment.\n (c) An award by an arbitrator shall be binding except where vacated or\nmodified by a master arbitrator in accordance with simplified procedures\nto be promulgated or approved by the superintendent. The grounds for\nvacating or modifying an arbitrator's award by a master arbitrator shall\nnot be limited to those grounds for review set forth in article\nseventy-five of the civil practice law and rules. The award of a master\narbitrator shall be binding except for the grounds for review set forth\nin article seventy-five of the civil practice law and rules, and\nprovided further that where the amount of such master arbitrator's award\nis five thousand dollars or greater, exclusive of interest and\nattorney's fees, the insurer or the claimant may institute a court\naction to adjudicate the dispute de novo.\n (d) (1) Except as provided in paragraph two of this subsection, where\nthere is reasonable belief more than one insurer would be the source of\nfirst party benefits, the insurers may agree among themselves, if there\nis a valid basis therefor, that one of them will accept and pay the\nclaim initially. If there is no such agreement, then the first insurer\nto whom notice of claim is given shall be responsible for payment. Any\nsuch dispute shall be resolved in accordance with the arbitration\nprocedures established pursuant to section five thousand one hundred\nfive of this article and regulations as promulgated by the\nsuperintendent, and any insurer paying first-party benefits shall be\nreimbursed by other insurers for their proportionate share of the costs\nof the claim and the allocated expenses of processing the claim, in\naccordance with the provisions entitled "other coverage" contained in\nregulation and the provisions entitled "other sources of first-party\nbenefits" contained in regulation. If there is no such insurer and the\nmotor vehicle accident occurs in this state, then an applicant who is a\nqualified person as defined in article fifty-two of this chapter shall\ninstitute the claim against the motor vehicle accident indemnification\ncorporation.\n (2) A group policy issued pursuant to section three thousand four\nhundred fifty-five or three thousand four hundred fifty-eight of this\nchapter shall provide first party benefits when a dispute exists as to\nwhether a driver was using or operating a motor vehicle in connection\nwith a transportation network company or peer-to-peer car sharing\nprogram when loss, damage, injury, or death occurs. A transportation\nnetwork company or peer-to-peer car sharing program administrator shall\nnotify the insurer that issued the owner's policy of liability insurance\nof the dispute within ten business days of becoming aware that the\ndispute exists. When there is a dispute, the group insurer liable for\nthe payment of first party benefits under a group policy shall have the\nright to recover the amount paid from the driver's insurer or in the\ncase of a peer-to-peer car sharing program, the shared vehicle owner's\ninsurer to the extent that the driver would have been liable to pay\ndamages in an action at law.\n (e) With respect to an action for serious personal injury permissible\nunder section five thousand one hundred four of this article, an award\nor decision of an arbitrator or master arbitrator or that is court\nrendered pursuant to subsection (c) of this section seeking no-fault\nreimbursement by or for medical providers, shall not be given collateral\nestoppel effect in any action or proceeding arising out of the same\noccurrence and shall not be admissible in any action or proceeding in\nactions seeking damages for bodily injuries, pain suffering, medical\ncare and loss of wages as evidence of any facts.\n